Your knee replacement
Information about your planned total knee replacement at the John Charnley Wing, Wrightington Hospital. Please read it carefully and discuss any questions with your healthcare team.
Why is a knee replacement recommended?
The most common reason is severe osteoarthritis, where the cartilage surfaces of the knee have worn away, leading to painful bone-on-bone contact. This causes:
- severe, persistent knee pain;
- stiffness and swelling;
- restricted mobility and difficulty with activities such as walking and climbing stairs.
A knee replacement is only recommended when non-surgical treatments (such as medication, physiotherapy and walking aids) are no longer giving enough pain relief or function.
Robotic assistance: the VELYS™ system
I use the VELYS™ Robotic-Assisted Solution (DePuy Synthes) for knee replacement. The knee robot is made by DePuy Synthes, a company that funds some of my research and whose courses I teach on. It pays me nothing for using it. See my disclosures.
- I am in control. The robot is a tool that assists me; it does not perform the surgery on its own. I remain in control throughout.
- Precision. The system uses optical tracking and real-time measurements to help plan and prepare the bones, so the components are placed precisely to the plan made for your knee.
The operation and preparation
| Pre-operative assessment | You will attend a clinic for tests (blood tests, ECG, X-rays) and a health check to ensure you are fit for surgery. |
|---|---|
| Medication and fasting | Specific advice about fasting times and which medications to stop or continue will be given to you by the Pre-Operative Assessment Team. Please follow their instructions exactly. |
| Admission | You will be admitted directly to the John Charnley Wing on the morning of your surgery. |
| Anaesthetic | The anaesthetist will discuss the best plan. Most patients have a spinal anaesthetic to numb the lower body, often combined with sedation, but the final decision is made after discussion with you. |
| Surgery | The operation normally takes under an hour. The damaged joint surfaces are removed and replaced with metal and plastic components (the prosthesis). |
After the operation: enhanced recovery at Wrightington
Our goal is to get you moving safely and home within 24 hours of surgery.
| Mobility | The aim is to get you up and walking on the day of surgery, for a quicker start to your recovery. There are no restrictions on your knee activity. |
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| Physiotherapy | The physiotherapists will help you get moving and encourage you to focus on bending and straightening your knee. |
| Rehabilitation | Choose a physiotherapist you get on well with and enjoy working with: that matters a great deal for a good rehabilitation programme and for staying motivated. Find someone convenient for you, near where you live: it makes it much easier to stick with your exercises. Physiotherapy after your operation is not included in the price of your surgery. |
| Walking aids | Crutches or sticks can be used and put aside as your pain and mobility improve; this can take days or weeks, depending on your own speed of recovery. |
| Before you go home | A full safety and function assessment makes sure you can manage safely at home. |
Risks and complications
All major surgery carries risks. I will discuss these with you in detail, but the main risks of knee replacement include:
| Complication | Approximate risk | Management |
|---|---|---|
| Stiffness | Common | Needs diligent physiotherapy and exercises. |
| Blood clots (DVT/PE) | About 2 to 3 in 100 within 90 days, mostly clots below the knee | Prevented with blood-thinning medication and early walking. |
| Infection | Low (about 1 in 100) | Prevented with antibiotics and sterile techniques. |
| Nerve or blood vessel injury | Rare | Can lead to weakness or numbness in the leg or foot. |
| Fracture around the implant | About 1 in 125 within five years and 1 in 60 within ten years | Can happen during the operation or after a fall; may need further surgery. |
| Heart attack | About 1 in 500 in the first six weeks | Your anaesthetist and I check your fitness beforehand. |
| Stroke | Rare: about 1 in 1,000 within 30 days | Your anaesthetist and I check your fitness beforehand. |
| Death | About 1 in 340 within 90 days | Higher in older people and those with other serious illnesses. Your anaesthetist and I check your fitness beforehand. |
| Ongoing pain | Studies report long-term pain in between about 1 in 10 and 1 in 3 people | Some people still have some pain or are not fully satisfied with their knee, even when the operation has gone well. |
| Implant loosening | Long term | The prosthesis may eventually wear or loosen, sometimes needing further surgery (revision) after many years. |
This leaflet does not list every risk. I will go through the risks that matter for you before you decide, and you will have time to think before you sign.
Life after your knee replacement
| Normal activities | Full recovery can take several months, but you can return to normal daily activities as soon as you feel able and comfortable. |
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| Driving | Only drive when: 1. you are not taking strong pain-relieving medication; 2. you are not distracted by pain or discomfort; 3. you feel safe and confident enough to perform an emergency stop. This is normally between 2 and 6 weeks after surgery. Check with your insurer before you drive again; some policies set their own rules. |
| Follow-up | After private surgery I check your recovery with a short questionnaire at about six weeks. I will see you in clinic if the answers suggest you need it, or if you would like a visit. Tell Michelle if you would prefer to be seen. |
| Long-term care | If you have any problems in future, contact Michelle (private) or the Arthroplasty Practitioner Service. |
If you have any further questions, please do not hesitate to discuss them with me or any member of the healthcare team in the John Charnley Wing. See when to get in touch and the contact page.